Velamentous cord insertion and vasa previa occur more frequently in monochorionic twin pregnancies than in singleton pregnancies. Both have been linked with poor perinatal outcome due to the increased risk of rupture of the velamentous vessels. We present a case of acute fetal distress in 2 fetuses in a monochorionic ...

BACKGROUND: Intrauterine death of one twin in the second or third trimester occurs in about 1% of all twin pregnancies. The retention in utero of the dead fetus may be associated with maternal disseminated intravascular coagulation. CASE: We present the case of a diamniotic monochorionic pregnancy with intrauterine death of ...

This study examined the incidence of perinatal morbidity and mortality in late pre-term and term dichorionic twins versus singleton delivery at the same gestation. There were no measurable differences in the incidence of the perinatal complications in relation to gestational age at delivery between singleton and dichorionic twin pregnancies. In ...

OBJECTIVE: To examine the outcomes of patients with twin reversed arterial perfusion (TRAP) sequence in which the acardiac twin was <or=50% the weight of the pump twin. METHODS: This was a retrospective study conducted with institutional review board approval. The records of all patients referred to UCSF for suspected diagnosis ...

Impact of fetal gender on prematurity has been primarily investigated in singleton pregnancies. In an attempt to understand better how fetal gender may affect gestational length in twin gestations after in vitro fertilization, same-sex twins and opposite twins were compared for pregnancy duration. This study evaluated 113 women at ages ...

OBJECTIVE: Laser coagulation of placental anastomoses in twin pregnancies complicated by severe twin-to-twin transfusion syndrome (TTTS) has been shown to be superior to serial amniodrainage, and has emerged as the standard therapy for this condition. We report the outcome of triplet pregnancies treated with laser therapy for severe TTTS. METHODS: ...

Monochorionic diamniotic twin pregnancies have a more hazardous intrauterine stay than their dichorionic counterparts because of the vascular anastomoses that connect the two fetal circulations. The survival of monochorionic twins diagnosed in the first trimester is 89%. Twin-to-twin transfusion syndrome (TTTS) occurs in 9% and is the most important cause ...

This was a retrospective study, carried out at Yeovil District Hospital, UK, from January 2006 to December 2008, looking at 40 patients with twin pregnancies. The aim was to evaluate the role of phosphorylated insulin-like growth factor binding protein-1 (IGFBP-1) test in the prediction of pre-term delivery in twin pregnancies. ...

Introduction: Infertility therapies have markedly increased the incidence of multiple pregnancies and concomitantly monozygotic twinning. In utero death of one monozygotic twin predisposes the survivor to death and serious morbidity from hemodynamic collapse, thromboplastins, or microemboli. The optimal management of such cases, however, is unclear. Methods: We compared single-twin demise ...

Dodd Jodie M JM Australian Research Centre for the Health of Women and Babies (ARCH), Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, Australia. - - 2010

There is a well recognized risk of complications for both women and infants of a twin pregnancy, increasing beyond 37 weeks gestation. Preterm birth prior to 37 weeks gestation is a recognized complication of a twin pregnancy, however, up to 50% of twins will be born after this time. The ...

Monochorionic twin pregnancies are associated with increased perinatal morbidity and mortality. The vascular placental anastomoses in these pregnancies can cause severe complications. We describe a case of twin anemia-polycythemia sequence (TAPS) with an atypical placental angioarchitecture. During pregnancy serial ultrasound examinations of both twins revealed no amniotic fluid discordance and ...

Cord entanglement is a leading cause of mortality of monochorionic monoamniotic twins. Few studies focused on entanglement features/structure itself. Three-dimensional color Doppler ultrasound was conducted to evaluate the cord entanglement in monoamniotic twins at 30 weeks of gestation. Ultrasound revealed detailed features: the two cords were entangled at several points ...

The aim was to compare obstetric outcomes of IVF singleton pregnancies diagnosed with vanishing twin (VT) syndrome with those pregnancies originating as singleton pregnancies and with twin pregnancies. In this case control study, 57 patients diagnosed with VT syndrome were matched and compared with 171 singleton controls and 171 twin ...

Monochorionic twins share a single placenta with inter-twin vascular anastomoses, allowing the transfer of blood from one fetus to the other and vice versa. These anastomoses are the essential anatomical substrate for the development of severe complications, including twin-twin transfusion syndrome (TTTS) and twin-anemia-polycythemia sequence (TAPS). TTTS and TAPS are ...

Spontaneous antepartum rupture of the dividing membrane occurring in monochorionic diamniotic twins (MD twin) is an extremely rare complication and difficult to diagnose prenatally. We present a case of pseudo-monoamniotic twins derived from an MD twin gestation, which was suspected by ultrasound and was confirmed by antepartum fetoscopy. A 28-year-old ...

Operative fetoscopy is a surgical approach to the in utero treatment of fetal or placental abnormalities. The approach is on the basis of combined use of ultrasound and endoscopy and minimally invasive access into the womb. Operative fetoscopy is associated with significantly less risk of preterm birth, neonatal morbidity, and ...

Monochorionic twin pregnancies have an increased risk of intrauterine and postnatal complications because of the present placental vascular anastomoses. The main problems are the development of twin-to-twin transfusion syndrome,selective intrauterine growth restriction, monoamniotic twins and single intrauterine death on the one hand and congenital abnormalities like twin reversed-arterial perfusion and ...

OBJECTIVE: To evaluate the total number of inter-twin contacts between monochorionic diamniotic (MD) and dichorionic diamniotic (DD) twins using four-dimensional (4D) sonography late in the first trimester of pregnancy. METHOD: Six MD and 8 DD pregnancies were studied for 30 minutes with 4D sonography at 10-11 and 12-13 weeks of ...

AIM: We examined whether the Doppler waveforms of the maternal renal main arteries are altered in women with twin pregnancy compared with those in singleton pregnancy. METHODS: The indices of vascular resistance and acceleration time of the maternal main renal arteries were obtained from 19 healthy women at 37-38 weeks ...

Twin pregnancies contribute a disproportionate degree to perinatal morbidity, partly because of increased risks of low birth weight and prematurity. Although the cause of the morbidity is multifactorial, attention to twin-specific maternal nutrition may be beneficial in achieving optimal fetal growth and birth weight. Achievement of body mass index (BMI)-specific ...

OBJECTIVE: The objective of the study was to determine whether cardiac troponin T (cTnT) and natriuretic peptides can be isolated from the amniotic fluid (AF) of pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) and whether they correlate with fetal echocardiographic findings and recipient survival. STUDY DESIGN: AF samples from the ...

OBJECTIVE: To examine the rate of spontaneous twinning in selected countries in order to evaluate the impact of environmental stress and related socioeconomic factors on balancing reproductive activity and longevity. STUDY DESIGN: Four countries with similar ancestry were considered, 2 in Africa and 2 in the Caribbean. Data on gross ...

Reversal of twin-twin transfusion syndrome (TTTS) is a rare complication of monochorionic pregnancy. Diagnostic criteria and satisfactory therapeutic options have not been reported. We make a suggestion of diagnosis and therapy for reversal of TTTS. We report two cases of reversal of TTTS. Measurement of the fetal urine production rate ...

A case of combined intrauterine and abdominal pregnancies in a 29-year-old primigravida occurring in a natural cycle is presented. She booked for routine antenatal care in the obstetric unit of the hospital. An early scan at 10 weeks showed a twin gestation (diamniotic, dichorionic placentation). She was admitted between 10-21 ...

There is no consensus about the safe time interval between the deliveries of twins. This retrospective study, conducted from 1 January 2000 to 31 December 2004 at the University Teaching Hospital of Yaound??, Cameroon, was designed to evaluate the safe time interval between deliveries of twins. We analysed 268 twin ...

OBJECTIVE: To review the outcome of twin pregnancies complicated by single fetal intrauterine death (IUD) managed at our Centre and to evaluate the neurological follow up of the surviving cotwins. STUDY DESIGN: Twenty-three twin pregnancies (10 dichorionic and 13 monochorionic diamniotic) complicated by IUD in the II or III trimester ...

OBJECTIVES: The role of middle cerebral artery (MCA) peak systolic velocity (PSV) has become established in the management of fetal anemia. To date, singleton reference ranges have also been used in twin pregnancies. However, in monochorionic twin pregnancies, normal ranges for cerebral blood flow may differ from those in singletons ...

OBJECTIVES: To study the frequency and clinical significance of crown-rump length (CRL) discrepancy at 11-14 weeks of gestation in twin pregnancies from an unselected population. METHODS: This was a retrospective analysis of all twin pregnancies that underwent a routine 11-14-week scan at a large teaching hospital. Fetal loss was defined ...

Traditionally, monochorionicity in multiple pregnancies is associated with monozygocity. We present a case of a spontaneous, monochorionic dizygotic, sex-discordant twin pregnancy. The diagnosis of monochorionicity was initially done during first-trimester ultrasound evaluation and then confirmed by postnatal placental pathology. Furthermore, both twins were found to have blood chimerism. We also ...

OBJECTIVE: Prenatal ultrasound has led to the early diagnosis of major anomalies. However, the ready availability of this technology has led to increasing challenges for physicians counseling affected parents, which is all the more difficult in a twin pregnancy with only one affected fetus. This paper reviews the medical and ...

Deformation twinning is often mediated by partial dislocation activities at the twin boundary. Using molecular dynamics simulations, we have uncovered a new mechanism for the most commonly observed {1012}<101 1> deformation twinning in Mg and other hexagonal close-packed metals. Here the twin growth involves no definable dislocations at the twin ...

Twin-twin transfusion syndrome (TTTS) is present in approximately 5-15% of monochorionic-diamniotic twin pregnancies. A chronic blood flow imbalance through placental vascular anastomoses from the donor to the recipient twin is considered the pathophysiologic mechanism responsible for the development of TTTS. Discordant echogenicity between the donor and recipient placenta has been ...

A successful pregnancy outcome with vaginal delivery of a term single live fetus in case of twin pregnancy with other twin papyraceous, (vanished in second trimester) is an uncommon finding. Ten percent of all perinatal deaths are related with dizygotic twins. The rate of intrauterine fetal demise in multiple pregnancies ...

OBJECTIVES: To assess whether early fetal growth restriction in a twin, expressed as the intertwin discrepancy in crown-rump length (CRL) between two viable twins at 7 + 0 to 9 + 6 weeks' gestation, is predictive of subsequent single fetal loss. METHODS: This was a retrospective analysis of data collected ...

Whereas monochorionic twins account for only 30% of twin gestations, they contribute to a disproportionate extent to the overall twin perinatal morbidity and mortality. Twin-to-twin transfusion syndrome can occur at any point in a monochorionic gestation but is associated with significant increases in both morbidity and mortality when it develops ...

The Beckwith-Wiedemann syndrome (BWS) is a growth disorder for which an increased frequency of monozygotic (MZ) twinning has been reported. With few exceptions, these twins are discordant for BWS and for females. Here, we describe the molecular and phenotypic analysis of 12 BWS twins and a triplet; seven twins are ...

Monochorionic (MC) twin pregnancies may develop significant complications, and twin-to-twin transfusion syndrome (TTTS) has become among the best known to obstetricians and patients alike. A significant percentage of patients referred for suspected TTTS have a different underlying pathologic condition, however, and differentiating the subcategories of MC pathophysiologic conditions may change ...

Twin to twin transfusion syndrome (TTTS) is one of the major complication of monochorionic twin pregnancy which is mainly understood by placental vascular anastomosis. Perinatal mortality and morbidity is high as 80-100% if untreated and even higher if the disease is developed at early stage. Variety of methods of isolating ...

AIM: A case-control study of twins was performed to identify clinical predictions of emergency cesarean delivery in the second-born twin after vaginal delivery of the first twin. METHODS: The obstetric records were reviewed of all twin vaginal deliveries at the Japanese Red Cross Katsushika Maternity Hospital from 2002 through 2007. ...

As ultrasound technology advances, diagnosis of fetal malformations, particularly congenital heart defects (CHD) is becoming standard practice. Currently, a key element of obstetrical care is the use of ultrasound to diagnose chorionicity in multiple gestations. Given the difference in incidence and types of complications between dichorionic and monochorionic pregnancies, early ...

Multiple pregnancy has increased in frequency as a result of the ageing maternal population as well as the advent and wider availability of assisted reproductive technologies. Higher-order pregnancies are associated with increased morbidity and mortality for both the foetuses and mother. The introduction of transvaginal ultrasound has made accurate diagnosis ...

OBJECTIVE: To report a unique case of successful pregnancy and delivery of two pair of monozygotic twins (quadruplets) after intracytoplasmic sperm injection (ISCI) and transfer of two blastocysts. DESIGN: Case report. SETTING: University medical center. PATIENT(S): A 30-year-old nulligravida, who had first ISCI, assisted hatching, and fresh embryo transfer because ...

OBJECTIVES: We sought to document the pregnancy and neurodevelopmental outcome in monochorionic diamniotic twin pregnancies and to identify risk factors for death and impairment. STUDY DESIGN: We conducted a prospective cohort study of 136 monochorionic twins followed up from the first trimester until infancy. RESULTS: A total of 122 (90%) ...

To document co-twin death/pregnancy loss and brain injury after single intrauterine death (sIUD) in monochorionic pregnancies. A total of 135 pregnancies with sIUD were reviewed for co-twin IUD, miscarriage and abnormal antenatal and postnatal neuro-imaging. A tertiary referral fetal medicine unit from 2000 to 2007. All cases referred with a ...

OBJECTIVE: The purpose of this series is to describe the prenatal diagnostic and management challenges of spontaneous septostomy of the dividing membrane (SSDM) in complicated monochorionic diamniotic (MoDi) pregnancies. METHODS: A retrospective review of all MoDi multiple gestations referred for fetal therapy was conducted. Spontaneous septostomy of the dividing membrane ...